早產兒口腔餵食與心肺功能調節之關係

The Relationship between Oral Feeding and Cardiorespiratory Regulation of Premature Infants

由於早產兒生理成熟及疾病因素，導致其在學習口腔餵食時心肺功能調節反應有個別性的差異，因而影響其餵食成效。由於觀察餵食過程的生理反應是護理人員的重要職責，故本文統整文獻探討早產兒口腔餵食與其心肺功能調節之機轉及關係，以增進護理人員之認知及臨床觀察之敏感度。本文統整四個重要概念：（1）早產兒可藉由成熟的吸吮技巧，配合吸吮、吞嚥和呼吸間的協調，進而提昇口腔餵食成效。（2）早產兒的口腔餵食與心肺功能調節具有絕對關係，心肺功能調節良好，餵食成效越佳。（3）早產兒在口腔餵食期間會降低迷走神經反應使心跳速率增加，以平衡身體新陳代謝機能，在餵食完後則會逐漸回復至餵食前之速率。（4）早產兒在口腔餵食初期的動脈血氧飽和濃度（arterial oxygen saturation, SaO2）持續低下情況，可藉由經驗累積逐漸達到成熟的口腔餵食動作來改善。這些概念可提供臨床護理人員開始嘗試早產兒口腔餵食時機的依據或參考，以避免過早及強迫口腔餵食而導致心肺負荷。

Levels of maturity and diseases of premature infants are factors that produce individual differences in cardiorespiratory responses to oral feeding and feeding performances. Recognition of mechanisms and cardiorespiratory regulation of oral feeding may increase sensitivity of clinical observation of nurses and facilitate safe and comfort feeding experiences for premature infants. Four major concepts of this integrated literature review are: (a) The maturation of sucking skills and coordination of sucking, swallowing, and breathing play an important role in successful oral feeding. (b) There are significant relationships between the feeding performances and cardiorespiratory stability of premature infants in the early period of oral feeding. (c) During the oral feeding period, the reduction of vagal tone will increase the heart rate of premature infants in order to balance physiological metastasis. (d) During the early period of oral feeding, the SaO2 of premature infants might decrease continually. This condition can be improved gradually with experience of oral feeding. These concepts provide knowledge for assessing feeding readiness and facilitate protocols for safe feeding by reducing the cardiorespiratory workload of premature infants.